Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A13690 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 20A13690 | CA |
NPI | 1093104309 |
---|---|
Provider Name | Eric Michael Hargis |
First Address | Downey, CA 90241-4917 |
Second Address | Downey, CA 90241-4917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2015 |
Last Update Date | 31/12/2021 |